LONDON (AlertNet) - The growing number of refugees fleeing Syria's civil war into Iraq, Jordan, Lebanon and Turkey as the humanitarian situation worsens, is putting increasing pressure on aid agencies trying to provide assistance.

More than 300,000 refugees have already fled during the 18-month conflict, and that number could grow to 710,000 by the end of this year, UNHCR, the U.N. refugee agency, says.

The number of registered Syrian refugees and those awaiting registration in Lebanon is now more than 80,800 and is expected to grow to 120,000 by the end of 2012, UNHCR reports.

Inside Syria, 1.2 million people have been displaced, the U.N. Office for the Coordination of Humanitarian Affairs (OCHA) reports.

As numbers increase and winter draws nearer, the need to improve access to food, shelter and medical assistance in Syria and refugee camps in surrounding countries is becoming more acute, said Fabio Forgione, head of mission in Lebanon for medical charity Medecins Sans Frontieres (MSF), also known as Doctors Without Borders.

Forgione discussed some of the challenges posed by the Syria crisis in an interview with AlertNet:

Q: What is the scale of the MSF operations with regard to the civil war in Syria?

A: The Syrian Crisis is one of the most important interventions that MSF is involved in, providing humanitarian support highly needed for the population displaced inside Syria and for refugees who for almost a year-and-a-half have been fleeing the conflict and are currently settling in neighbouring countries. Today, the bulk of the MSF operations are in the neighbouring countries, namely Lebanon, Jordan and Iraq, with programs varying from primary care to chronic medication, and surgical intervention for wounded Syrians fleeing the country.

Q: Is MSF working inside Syria?

A: MSF has been trying to get official authorisation to work within Syria, but until now it has been unsuccessful. Our intervention in Syria has been very much limited. So for the time being basically we are running two field hospitals inside Syria, which is very limited capacity - considering that our presence hasn't been officially authorised by the Syrian authorities. Nevertheless, we're still providing medical equipment and materials from neighbouring countries through a network of Syrian doctors moving between Syria and the neighbouring countries, mostly Lebanon and Turkey. This cannot happen regularly and on the scale which the magnitude of the conflict and therefore the medical needs would require. The core of our activities are in Lebanon, in Jordan, in the refugee camp that recently opened in Kurdistan and although with limited capacities and response, inside Syria too.

Q:What is your general strategy?

A: For MSF, the key objective is to make sure we ensure proximity and therefore quality in delivering service to the parts of the population in need of it. The Syria conflict - especially with regard to our intervention inside Syria - is a bit different because we haven't yet received official authorisation from the authorities to be able to work inside Syria. This principle of proximity and healthcare for the population is endangered by the fact that security is extremely volatile, and we want to make sure that the MSF staff involved in this operation have security in place. This normally is done by making sure that all the most relevant stakeholders involved in the crisis are informed about our presence.

Q: How can you be there at all if you haven't received official permission?

A: We try to be able to have MSF staff entering Syria with the support of a network of doctors established before, but it's not a legal and acknowledged presence by the authorities. The response being provided by the international community with regard to the Syrian crisis, specifically in Lebanon. definitely does not yet match the needs. The response has come later when the conflict - and therefore the flow of refugees - had already started and with the winter season arriving soon, there are still very important needs not yet in place.

Q: What kind of budget do you have?

A: In terms of budget, a rough estimation of what MSF has been allocating for the response to the Syrian crisis is around 4 to 5 million euros ($5 to $6 million), which increases and decreases according to the possibility that MSF has to develop the activities in the different areas in which we work. For the time being we have been allocating a budget for the response to Syrian refugees in Lebanon for around 2 million Swiss francs ($2 million), which includes the branding of several clinics which we are managing or supporting in different border areas between Lebanon and Syria.

Q: How many people are you helping?

A: In terms of numbers, it's quite difficult to establish what exactly our target population is and this is due to different reasons. In Syria, there are clear problems in terms of access, while in the neighbouring countries - more specifically Lebanon - there are high constraints in terms of registration of the refugees, which of course makes their numbers fluctuate very much, and don't give us precise opportunities to quantify the number of refugees which are currently present for example in Lebanon.

Q: What kind of care are beneficiaries receiving?

A: [Treatments include] primary care, chronic medication and mental health in Lebanon. Basically, psychological support for the Syrian refugees crossing the border and normally affected by a high degree of psychological distress. Primary care includes check up, vaccination for children, antenatal care for pregnant women, includes treatments for more average diseases or illnesses like respiratory infection, diarrhoea, bronchitis, fever, etc., etc.

Q: Are you treating the wounded?

A: In Lebanon we are not dealing directly with wounded because there are a few other organisations - international and regional organisations - which are dealing with the wounded. We believe that today one of the main gaps which is important for MSF to cover is specifically related to primary care and chronic medication - various -- very expensive medications to be taken by patients for very long periods. We are really focusing on making sure that medication - free of charge - is readily available for the beneficiaries – so not specifically focusing on the wounded.

Q: Can you give a sense of what challenges you face?

A: Until the end of June when funds were available, the response provided by the Lebanese government - especially in terms of medical care to the Syrian refugees - was according to us commendable. Things have have changed since July when eventually funds ran out. Now the coverage of medical care, shelters, food, etc. -- is basically led only by international NGOs (non-governmental organisations). When it comes to drugs for the Syrians, there's a small percentage still provided by the government in Lebanon. Of course, also due to constantly increasing numbers of refugees coming to Lebanon, this cannot be absolutely enough and therefore it is vital to have medical NGOs like us, for example, playing the most prominent role when it comes to the provision of drugs and medicines and medical equipment required for the health care of therefugees.

Q: What are the main medical needs now?

In terms of main medical needs in accordance with what we can see, definitely we need to reinforce hospitalisation services. Not only hospitalisation and medication for wounded, but for those Syrians who need to get secondary care for emergency treatment. It's necessary to make sure it is available for the longer term. Secondly, even the availability of chronic medication -- according to our figures 25 percent of the patients accessing our services are in need of chronic medications or suffer from chronic diseases. It's very important to make sure that such medication is available not only now but even in the longer term. It's extremely important to make sure that ... there will always be a presence of social workers and psychologists to try and release the psychological burden suffered by the Syrians.

Q: Are there any diseases appearing that tend to strike people in times of crisis?

A: Not for the time being. We're not witnessing any conflict-related disease or epidemic due to the conflict. We're concerned that due to the degeneration of the situation in Syria where the latest reports talk about a very concerning lack of food, we might potentially experience a situation of displaced with a certain degree of malnutrition, which has certainly not been the case yet, but that is something that might potentially come out later if the conflict protracts in Syria.

Q: If the conflict continues what would you foresee happening?

A: We have strong concerns that this could bring about a deterioration of the general healthcare system, which seems to be already collapsing in Syria and also in Lebanon. For example, it isn't enough to continue to receive an increasing number of refugees, so definitely there should be much more important commitments even from the international community to make sure that medical needs, shelters and accommodation should be available especially in the longer term. Even if a political solution was potentially found for the Syrian crisis, definitely the problem of the refugees is an issue that will last for a very long time, considering the majority of refugees have nothing left in their own country. Their presence in the neighbouring countries will last for a very long time.

(Editing by Tim Pearce)

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